Supporting children with speech,
language and communication
needs within integrated
children’s services
Position Paper
Marie Gascoigne
January 2006
www.rcslt.org
Referencing
This document should be referenced as follows:
Gascoigne M. (2006)
“Supporting children with speech, language and communication needs within integrated children’s services”
RCSLT Position Paper, RCSLT: London
This document is available from the RCSLT website: www.rcslt.org
2
Supporting children with speech, language and communication
needs within integrated children’s services
Contents
1. Introduction
2. Reviewing the context
2.1 Changing context for children’s services across
the UK
2.2 Commissioning integrated services for children
2.3 Delivering integrated children’s services through
multi-agency models
2.4 Workforce review
2.5 Theoretical models for speech and language
development
2.6 Current professional consensus
2.7 Summary of the context
3. Articulating the vision: focus on impact
3.1 Delivering effective support
3.2 Planning for maximum impact
3.3 Systems for strategy
3.4 Developing the workforce
4. Conclusions and way forward
3
www.rcslt.org
Acknowledgements
Many have contributed to the final version of this paper
and much experience and professional expertise has been
shared in debating and refining the key recommendations
outlined as well as their underpinning principles.
The 100 or so delegates to the Children’s Services event
held in September 2004 enabled a representative sample
of the professional membership to discuss models of
service delivery and explore the professional consensus
regarding ‘good practice’ in terms of the contribution of
the speech and language therapist to the support of
children with speech, language and communication
needs. Thanks to all those who attended and to those
who commented on drafts of the paper.
This event was planned and facilitated by a steering
group consisting of members of the RCSLT Education
Committee alongside additional representatives from
the four UK countries as well as the independent and
voluntary sector: Mary Auckland, Pauline Bierne, Kate
Davies, Sarah Fisher, Yvette Johnson, Rosie Jones, Maria
Luscombe, Nita Madhani, Nigel Miller, Pat Mobley, Jane
Oates, Judy Roux, Liz Shaw, Alison Stroud, Shelagh
Urwin, Anne Whateley and Fiona Whyte.
4
Thanks also to members of the Professional Development
Board and Management Board for helpful comments on
drafts of the paper.
The practice example boxes sited throughout the paper
aim to bring reality to some otherwise abstract concepts.
Examples evidence practice across the profession and
individual contact details are available throughout the
document.
It has been particularly helpful to have had the
contributions from representatives of the voluntary sector,
especially ICAN and SLTs in independent practice.
Particular thanks are due to the following individuals who
have offered detailed comments and feedback at various
stages of the development of this paper. James Law and
Nicola Grove provided useful suggestions from an
academic perspective, which were extremely helpful and
have contributed significantly to the final structure of the
paper. Finally, Sue Roulstone and Kamini Gadhok have
not only contributed to the paper but have also provided
advice and guidance throughout the process of
producing this document.
Supporting children with speech, language and communication
needs within integrated children’s services
Executive summary
Introduction
This paper has been written so that the Royal College of
Speech and Language Therapists (RCSLT) can respond to
requests from respective UK governments for the
profession’s view and position regarding the role of the
speech and language therapist (SLT) within the changing
context and development of children’s services.
The paper will also serve as a reference for speech and
language therapy services, commissioners from health
and education, and other key stakeholders. The RCSLT is
aware of the need to define and develop best practice
within the context of national policy frameworks and
considers this paper as crucial in informing this work.
A number of key policy initiatives over the past three to
five years are analysed in section two. There is also a brief
summary of theory underpinning intervention for
communication disability.
Together, these provide a convincing backdrop to the
vision of future speech and language therapy services,
which is set out in section three: Articulating the vision:
focus on impact.
The paper sets out 15 recommendations that support
four key areas:
•
•
•
•
Delivering effective support
Planning for maximum impact
Systems for strategy
Developing the workforce
As a member-led organisation, the RCSLT recognises the
importance of involving the profession in the development of
this paper in order to achieve consensus. Consequently, the
paper sets out a framework that has been tested by the author
with members from across the four UK countries, as well as
from key groups, such as practitioners in independent practice,
the voluntary sector and higher education institutions (HEIs).
The RCSLT envisages that, as well as informing our joint
working within each of the home countries, the paper will
also provide SLTs with a framework to support local
service development and delivery. However, the paper is
not a service planning document. The aim of the paper is
to capture and disseminate key principles that the RCSLT
believes should underpin service commissioning and
provision. It will therefore provide a framework that UK
service planners and managers can use to develop services
that will best meet the needs of children with speech,
language and communication needs.
The focus of the paper is the role of the SLT. However, the
principles outlined could well be applied to other AHPs
working with children and to other professional
colleagues within integrated children’s services.
The pace of policy development and change during the
preparation of this paper is a testament to the
modernisation agenda in public services. Consequently,
the recommendations outlined within the paper are
viewed as time-limited and a review will be necessary in
2008 – a significant time in so many of the policy agendas
influencing the document.
5
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Key area 1
Delivering effective support
Recommendation 1:
Any speech and language therapist (SLT) working with children should:
• Identify the speech, language, communication or eating/drinking needs of the child as
part of, or with reference to, the appropriate multidisciplinary team (this does not imply a
static membership, more the team of relevant professionals for the individual child)
• Identify the functional impact of these needs
• Consider the most appropriate context for support ie. which settings are most relevant to the
child and their family
• Identify the contribution of the speech and language therapist as part of the wider team working with the child to meet the child’s needs – including the full range of options from advice
to colleagues through setting up programmes to direct intervention where appropriate.
Recommendation 2:
Services should offer the full range of support for children, including direct intervention where
appropriate, while ensuring overall management includes goals relating to activity and
participation, managed by those most relevant the child.
Recommendation 3:
The RCSLT regards trans-disciplinary working as central to work with children. The RCSLT
supports the exploration of SLT roles within trans-disciplinary models and the development of
new models that maximise the contribution of SLTs while ensuring that the specialist
contribution to the system is recognised as essential. Emerging key worker roles and lead
professional roles are also central to this model of working if it is to be successfully
implemented for the benefit of children and their families.
Recommendation 4:
Training of others, including parents, should be viewed a central activity for SLTs to
maximise impact for the child and their family.
Key area 2
Planning for maximum impact
Recommendation 5:
Service planning for children with speech, language, communication or eating/drinking
needs should always be in partnership with other agencies.
Recommendation 6:
Service planning should take account of the most functionally communicative and socially
appropriate environment for effecting change.
Recommendation 7:
There is a need to define the parameters of an appropriate advisory needs-based and
dynamic approach to supporting children which integrates the concept of skill mix both
within the profession and across professional boundaries. The term ‘consultative’ model
should be replaced by a more accurate description of the service being delivered. The RCSLT
supports the need for research to further define and investigate the impact of approaches,
which rely on the implementation of speech and language therapy advice by others.
Recommendation 8:
Service structures should reflect the changing context. Highly specialist, principal and
consultant therapists need to use time to train, develop, coach and mentor less experienced
therapists, who in turn need to be given the opportunity to work with all caseloads. The most
specialist need to focus their skills on the strategic developments within their specialist area.
6
Supporting children with speech, language and communication
needs within integrated children’s services
Key area 3
Systems for strategy
Recommendation 9:
The RCSLT recommends that within each local authority area there needs to be an SLT
professional lead for children, who can interpret national policy and ensure partnership
working occurs in terms of integrated commissioning of speech and language therapy
provision, strategic planning and operational delivery. This professional lead should ideally
be a member of key strategic multi-agency planning groups and be empowered to make key
strategic decisions on behalf of local speech and language therapy services.
The role of professional lead should also provide a focal point in terms of professional
standards for all speech and language therapy provider services both within statutory and
non-statutory provider organisations (including independent practitioners).
Recommendation 10:
The role of the SLT must be seen within the context of the specialist and wider workforce.
Commissioners need to be aware of the unique contribution of SLTs across the population
base.
Recommendation 11:
Managers and service leads should work together with their allied health professional (AHP)
colleagues as well as colleagues from education and social care, in the development of new
roles, in particular the development of consultants/specialist advisory posts and crossagency posts.
Recommendation 12:
Management opportunities across agencies and across professional boundaries should be
developed.
Key area 4
Developing the workforce
Recommendation 13:
The RCSLT supports the development of placements that offer student therapists a full
range of opportunities as part of their practice-based learning and this would include
working as part of trans-disciplinary teams.
Recommendation 14:
Speech and language therapists working with children should undertake continuing
professional development (CPD) activities across health, education and social care in order
to develop knowledge and skills that will prepare them for cross-agency roles. The RCSLT
values CPD activities that are not limited to the health context.
Recommendation 15:
The challenges of the changing context mean that business and entrepreneurial skills sets
will become more relevant for senior managers. Excellent communication and negotiation
skills should also be developed by all speech and language therapy service leads as part of a
portfolio of leadership competence.
7
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1. Introduction
This paper has been written so that the Royal College of
Speech and Language Therapists (RCSLT) can respond to
requests from respective UK governments for the
profession’s view and position regarding the role of the
speech and language therapist (SLT) within the changing
context and development of children’s services. The paper
will also serve as a reference for speech and language
therapy services, commissioners from health and
education, and other key stakeholders.
Approximately 70% of the 10,000 SLTs registered in the UK
work with children. It is estimated that approximately 6-8%
of children aged between 0-11 years have speech, language
and communication needs1. The prevalence for children
with severe and complex needs may be a further 1%.
The RCSLT is aware of the need to define and develop
best practice within the context of national policy
frameworks and would consider this paper as crucial in
informing this work.
As a member-led organisation, the RCSLT recognised the
importance of involving the profession in the
development of this paper in order to achieve consensus.
Consequently, the paper sets out a framework that has
been tested by the author with members from across the
four UK countries, as well as from key groups such as
practitioners in independent practice, the voluntary sector
and higher education institutions (HEIs).
8
The RCSLT envisages that, as well as informing our joint
working within each of the home countries, the paper will
also provide SLTs with a framework to support local
service development and delivery. However, the paper is
not a service planning document. Its aim is to capture and
disseminate key principles that the RCSLT believes should
underpin service commissioning and provision. It will
therefore provide a framework that UK service planners
and managers can use to develop services that will best
meet the needs of children with speech, language and
communication needs.
The focus of the paper is the role of the SLT. However, the
principles outlined could well be applied to other allied
health professionals (AHPs) working with children and to
other professional colleagues within integrated children’s
services.
The pace of policy development and change during the
preparation of this paper is a testament to the
modernisation agenda in public services. Consequently,
the principles outlined within the paper are viewed as
time-limited and a review will be necessary in 2008 – a
significant time in so many of the policy agendas
influencing the document.
Supporting children with speech, language and communication
needs within integrated children’s services
2. Reviewing the context
2.1 The changing context for children’s services
across UK
The legislative and policy agendas for children’s services
across the four UK countries have moved in the same
direction over the past three to five years, albeit with
some local variations. A useful summary is available in the
4 Nations Child Policy Network, showing the policy and
legislation affecting children2.
The common themes that emerge across the UK include:
• The need for statutory services to integrate delivery of
services around the child and their family. Examples of
this include the development of Sure Start (Sure Start
Scotland, Sure Start NI, Cymorth in Wales) initiatives
such as Children’s Centres 3 4 5 6, the Early Support
Programme7 and the development of Children’s Trusts
or their equivalent 8
• While terminology may differ from country to country,
a recognition that all agencies working with children
have a key role to play in all aspects of the child’s
development in order for them to achieve the five
outcomes to:
i. Be healthy
ii. Stay safe
iii. Enjoy and achieve
iv. Make a positive contribution
v. Achieve economic well-being 9
• A focus on inclusion of children with special (or
additional) needs in mainstream settings and the need
for specialist services to be delivered flexibly in order to
enable inclusion 10 11 12 13
• Emphasis on targeting services to address inherent
inequalities due to disadvantage of whatever sort (Sure
Start initiatives, Looked After Children).
• The move to developing primary care services and the
increasing focus on health promotion14
• Recognition of a changing workforce profile and the
need to examine and redesign professional roles
focusing on the competences required to deliver new
integrated services 15 16
Figure 1
In England, the papers Creating a Patient-led NHS 17 and
Commissioning a Patient-led NHS 18 signify far-reaching
changes to the mechanisms for service provision.
Therapists working in children’s services may in the future
be providing care for children whilst being employed by
local authority-based children’s trusts, new therapy
organisations (including companies limited by guarantee,
charitable organisations, independent provider consortia),
or possibly as employees of foundation hospitals. The key
themes of contestability and plurality in these policy
papers will result in the need for services to be offered in
ways that offer commissioners (whether from health,
education or social care) packages that are clearly
understood in terms of positive impact on the relevant
population.
It will also be critical for SLTs and other colleagues to
become involved in commissioning in order to influence
the commissioning processes and ensure that the added
value of therapists is understood.
The challenge for SLTs, along with other AHPs, and
colleagues in education and social care, is to respond
to this changing context proactively and creatively.
In order to respond, it is necessary to have a clear
understanding of the key drivers and resistors that are in
play and to be able to develop creative solutions.
There are capacity issues, both in terms of numbers of
individuals needed to deliver the agenda, but also in
terms of competences needed. New roles require
different skill sets. A change programme as significant as
that which we are experiencing for children’s services
across the UK will need to address capacity issues at
every level, from pre-registration to expert practitioner,
and also in terms of management and leadership
capacity.
Figure 1 (below) represents the key issues as a ‘forcefield’ 19 diagram. This identifies key themes clearly and sets
the framework for exploration of these issues in this paper.
Force field diagram showing key drivers and resistors within the context
of integrated children’s services
Legislative and policy framework
Challenge of communicating the scope and scale
of the proposed change
Workforce strategy
Professional expectations of the familiar career
framework
Services built around the child facilitated by new
organisational structures
Services currently build around historical structures
with embedded organisational cultures
9
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2.2 Commissioning integrated services for
children
Commissioners for children will take overarching policy
leadership for children’s services across the traditional
boundaries of health, education and social care nationally 20 21 22.
These posts are established in England, Wales and
Northern Ireland, whilst in Scotland the Scottish Executive
is evaluating the added value that a single commissioner
would give 23. Locally, services will see the appointment of
directors of children’s services or lead chief officers for
children (Wales 24) whose role will be to ensure redesigned
services meet the needs of all children, including those who
are vulnerable and/or have additional specialist needs, as
locally and flexibly as possible.
Vulnerable children and those with additional needs form
part of the population of ‘all children’. In an inclusive
society, specialist and targeted services for these children
should be integral to universal mainstream provision.
The integration of education, health and social care for
children means they should be able to access all the
services they require – whether universal, targeted or
specialist, flexibly and locally wherever possible. Figure 2
(right) shows how the range of services and the needs of
the child population interface. For example, children with
additional needs may access universal, targeted and
specialist services from all agencies, while the majority of
children will access universal service only.
Integrated services may or may not take the form of
children’s trusts. For example, in Wales, children and young
people partnerships within each local authority area provide
a similar function. In Scotland, community health partnerships bring together health, education and social services.
In all cases the single commissioner for children (or
equivalent in Scotland) will ensure services are commissioned
in an integrated way and that joint funding streams are
established as appropriate. The aim is to avoid duplication
of services and use resources in a more effective way.
Within the health sector, the implementation of practicebased commissioning highlights the need for a full
understanding of the scope of practice of SLTs and range
of service delivery for children with speech, language and
communication needs. Equally, commissioners in education
and social care (including head teachers as well as children’s
trust commissioners) will need to accept greater responsibility
for commissioning aspects of the services provided for
children with speech, language and communication needs.
The use of ‘pooled budgets’ under Section 31 of the
Health Act 1999 25 is an example of existing mechanisms
for integrating resources and the services they fund. There
are relatively few examples of these processes being used
to provide more effective support for children with speech,
language and communication needs. However, the use of
aligned budgets, where many of the flexibilities of a
pooled budget are possible but the financial accounting
systems retain the budgets within individual organisations,
is beginning to increase. The development of children’s
trust arrangements will no doubt result in a greater focus
on these flexibilities.
10
Figure 2
Population of children and
the services provided
Specialist
services
Targeted services
Universal
services
Children
with
additional needs
Vulnerable
children
All children
Practice example 1
Example 1a – Pooled budget
The Medway pooled budget was set up in 2000 using
matched funding from Medway PCT and Medway
Council to meet the speech and language needs of
children in special educational placements and
mainstream primary schools in the Medway towns.
The Medway Communication Team supports children
in mainstream primary schools from year one to their
transfer to secondary school. It is a multidisciplinary
team consisting of therapists, specialist language
teachers and two SLT technicians – one for speech
sounds and one for social skills. The skill mix enables
children who need to be seen by a therapist to have
access to one, while allowing all children with speech
and language difficulties access to SLT support.
Contact Dawn West on 01634 812858 or
dawn.west@nhs.net
Example 1b – Aligned budget
The integrated speech and language therapy service
for children in Hackney is a service jointly managed
across City & Hackney PCT and The Learning Trust
(the body responsible for education in Hackney) and
staff are employed flexibly on either PCT or Learning
Trust contracts and terms and conditions. The
budgets are held separately in each organisation, but
there is one manager with overall responsibility for the
service who is supported by management accountants
in both organisations. This method of working has
allowed the service to move forward operationally at a
greater pace than might have been the case had
formal ‘pooled budgets’ been pursued.
Contact Marie.Gascoigne@chpct.nhs.uk
Supporting children with speech, language and communication
needs within integrated children’s services
2.3 Delivering integrated services through
multi-agency models
The delivery of services through integrated systems and
processes has been conceptualised within the Every Child
Matters framework as shown in the diagram below 26.
This model shows the importance of integrating thinking
at every level to provide an integrated package as an
outcome to the child.
In Early Years these changes are being effected through
the development of children’s centres and the mainstreaming of Sure Start and similar initiatives27. Early
education is provided alongside family support and
relevant health services (including speech and language
therapy specifically).
Extended schools and learning communities provide a
similarly community-focused base from which families can
access services for older children and young people.
ency Gove rn
g
A
rt e d Stra an
te e gr a
c
t
t
In rate d Pro e gy e
eg o n t - c ess
t
Lin
In d F r
e e
ty
i
lie
ni
Fam
Parents
very
Outcome
for children and
young people
e li
Inte g
s
te
D
ra
In
In England, the use of the of the Early Support
Programme targeted at the child with complex needs
introduces the concept of a key worker or lead
professional to guide the family through the maze of
support needed for their child. Other examples of this
approach include the wraparound project in Northern
Ireland 28.These and other programmes embrace the ‘team
around the child’ 29 approach, where pathways are
developed with the child’s needs at the centre and
traditional professional pathways are secondary.
s C o mm
u
11
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2.4 Workforce review
Integrated commissioning sits alongside workforce review
and the emphasis on competency based profiling of roles.
The RCSLT has been proactive in this area in recognising
the need for a competency-based framework30 31. The
Children’s Workforce Strategy32 emanating from the
Department of Education and Skills (England) and the
UK-wide Skills for Health33, share the ambition of
redesigning the workforce to meet the needs of the
service user without assuming restrictions of existing
professional boundaries. These cross-disciplinary and crossagency reviews of competences, needed to deliver support
for children with varying needs, present
a challenge to all discrete professions.
The RCSLT is actively encouraging SLTs to respond to
these shifts in policy and engage in role redesign. Part of
this process is to recognise which skills and competences
are unique to an individual who has a professional
registration as an SLT and which are shared with others
(or could be shared with others). Alongside this, the
opportunity to develop new roles across traditional
professional and agency boundaries must be exploited.
2.5 Theory underpinning intervention for
speech, language and communication needs
Language is the unique attribute that defines us as
humans; it is the key tool we use in shaping our
understanding of the world, in transmitting our culture
from generation to generation and in forming and
maintaining social relationships. It is also the key/main
medium of education. Children are surrounded by
language and for those who have difficulties acquiring
language, their difficulties pervade most aspects of their
everyday lives – interactions with families, attempts to
make and keep friends, learning about their world and
their education.
Children learn language in a social context that provides
them with opportunities and motivation to interact and
that provides feedback on the success of their
communicative attempts.
In order to effectively support children with speech and
language impairments, interventions must consider how
best to shape all these different contexts. As long ago as
1978, Bloom and Lahey 34, talked about intervention that
addresses the entire communication context in terms of:
•
•
•
•
Children’s opportunities to communicate
Reactions children receive
Topics of conversation that are available
The language models (grammar, vocabulary, sounds)
they hear
• The modality used (adapted from Bloom & Lahey, 1978)
The delivery of intervention following these principles
requires a team around a child to structure the activities
and interaction opportunities of a child’s everyday life. It is
therefore necessary and appropriate for teams rather than
sole SLTs to deliver intervention. Equally as important as
the form, content and use of language, as outlined by
Bloom and Lahey, is recognising the child and their
communication within the wider context in which they
exist.
12
Brofenbrenner’s Ecological Systems Theory 35 demonstrates
the interaction between levels within the child’s
environment and highlights the need to address issues
and difficulties across the ecosystem in order to effect real
change in the child.
Figure 3 (top right) illustrates how the child is placed
within the wider context and that the child’s development
will be partly dependent on the feedback within the
system with interactions at all levels.
The understanding that the child in isolation cannot be
meaningfully supported underpins much of the integrated
children’s agenda outlined above.
In terms of professional practice, the International
Classification of Functioning, Disability and Health
(ICIDH-2)36 classification of impairment, activity, and
participation provides a framework for examining the
focus for professional input within the wider context.
This framework considers input in terms of the desired
impact for the child. Intervention can be targeted at the
following levels as shown in diagram opposite:
• Impairment – within the child
• Activity – addressing the impact of the impairment
on the child’s ability to do certain activities
• Participation – considering the impact of the
impairment and restricted activity in terms of the child’s
ability to participate as they would like within their
particular context
Supporting children with speech, language and communication
needs within integrated children’s services
Figure 3 after Brofenbrenner (1989)
Societ y
m un it y
Com
Fa m ily
Child
Interaction
The focus for input
When should
SLTs be working
at the level of
impairment?
Impairment
Activity
Assessment and
diagnosis?
Intervention?
Participation
Across all types
of child?
When should
SLTs be working
at the level of
activity?
i.e. working
to address
the impact of
the impairment
on the
individual’s
activities
When should SLTs be working at the level of participation? Working to ensure
that the individual opportunities for participating fully are maximised. Should
this be all children? Vulnerable children? Children with specific additional needs?
13
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2.6 Current professional consensus – what is
good practice?
The RCSLT Clinical Guidelines by Consensus 37 published in
2005 following extensive consultation with expert groups
within and beyond the profession, provide a comprehensive
summary of the evidence base for different fields within
speech and language therapy, including working with
children across a range of disorders and a wide age range.
•
•
•
•
•
•
Communicating Quality 2 (CQ2)38 provides the professional
standards to which all registered SLTs agree to adhere.
The third edition of Communicating Quality is due to be
published early in 2006 and this will provide updated
information that takes account of the significant changes
in the external context over the past decade.
In addition, delegates were asked to consider:
Neither of these texts, however, provides information
regarding the models of service delivery found to be most
effective – the former focuses on the impairment level and
the latter on professional standards. In order to inform
this paper the RCSLT held a UK- wide forum on children’s
services in September 2004. A representative sample of
SLTs from across the four UK countries, as well as from
statutory, voluntary and independent sectors, was invited
to attend a one day event. Delegates were presented with
the policy direction from all four countries and asked to
consider a number of case studies. The case studies were
explored in facilitated small groups. The brief was to
consider the following issues within a potential future
framework of integrated children’s services:
2.7 Summary of the context
The Every Child Matters: Change for Children programme 39,
while England-based, encapsulates key policy direction
that is echoed in Scotland, Wales and Northern Ireland.
The move towards integrating children’s services is a
common direction of travel across the UK. The
combination of changing legislative framework for
children’s services, changing organisational infra-structure
and changing workforce strategy results in a momentum
for change which has not been evident in the past.
The RCSLT and its membership need to be visionary in
responding to the opportunities and challenges at this
time.
14
What are the desired outcomes for the child?
What interventions are required to achieve these?
Why are these appropriate interventions?
How can the desired outcomes be achieved?
Where does the intervention take place?
Who delivers the intervention?
• Who commissions the interventions?
• Who funds the interventions?
Delegates were also asked to have in mind the need to
consider the full scope of intervention based on the
ICIDH-2 classification of impairment, activity, participation
as outlined above.
The outputs from the case studies indicated there is
consensus regarding key features of good practice in terms
of ensuring that the contribution of the SLT is set within a
wider context in order to be effective and to have maximum
impact on the child and their family. Clear themes include
desired outcomes that highlight activity and participation
goals as well as impairment goals, speech and language
therapy interventions as part of a wider package of
support, flexibility in terms of where and how support is
delivered, and the need for SLTs to work as part of wider
multi-professional and inter-agency teams.
Supporting children with speech, language and communication
needs within integrated children’s services
3. Articulating the vision:
focus on impact
3.1 Delivering effective support
Recommendation 2:
In a continually evolving and dynamic system, it is not
possible, or desirable, to identify ‘good practice’ as a
narrow construct. However, in order to maintain a
professional integrity in a rapidly changing context, it is
necessary to identify some key elements that need to be
present in any context where an SLT is working with
children.
Services should offer the full range of support for
children, including direct intervention where appropriate,
while ensuring that overall management includes goals
relating to activity and participation, managed by those
most relevant the child.
Recommendation 1:
Any SLT working with children should:
• Identify the speech, language, communication or
eating/drinking needs of the child as part of, or with
reference to, the appropriate multidisciplinary team (this
does not imply a static membership, more the team of
relevant professionals for the individual child)
• Identify the functional impact of these needs
• Consider the most appropriate context for support ie.
which settings are most relevant to the child and their
family
• Identify the contribution of the SLT as part of the wider
team working with the child to meeting the child’s needs
– including the full range of options from advice to
colleagues through setting up programmes to direct
intervention where appropriate.
Figure 4
Figure 4 40 (below) illustrates how packages of support can
be classified according to the lead responsibility and focus
of intervention. The underlying philosophy is that if
intervention and support are effective a child will typically
follow the direction of the arrow. It is fully acknowledged
that not all children will be able to move away from an
SLT-led package. However, there is an important premise
that for all children the need to have interventions, which
are focused on activity and participation that are
embedded within the relevant context, is essential.
Service model for packages of support
TRAINING
LEAD
RESPONSIBILITY
school/setting
parent
other professional
School run language
group
Individual speech
programme with
modelling
SLT set up Language
Group
PCI
Children centre based
speech and language
groups
Speech and
Language Therapist
Individual
assessment
Speech
Group
Curriculum
planning and
differentiation
Language for
Thinking
Package
Social
skills
group
Parent training
with SENCO
Playground
games group
Hanen
Curriculum
based/
classroom
group
Classroom
Strategy
Modelling
Central training
School INSET
Training
Staff training
Social
communication/
complex individual
Individual language
programme with
modelling
Home visit for therapy
and modelling
‘Talking
Time’
Individual assessment
in context
Participation
Impairment
FOCUS OF INTERVENTION
15
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Recommendation 3:
The RCSLT regards trans-disciplinary working as central
to work with children. The RCSLT supports the
exploration of SLT roles within trans-disciplinary models
and the development of new models, which maximise the
contribution of SLTs while ensuring the specialist
contribution to the system is recognised as essential.
Emerging key worker roles and lead professional roles are
also central to this model of working if it is to be
successfully implemented for the benefit of children and
their families.
The concepts of interdisciplinary and trans-disciplinary
working are familiar in multidisciplinary teams and show
the potential for service delivery to be streamlined for the
child and their family when teams are working so closely
together (Figure 5 – Models of multi-professional
working 41). For this model to be successfully implemented
it is essential that there is clear understanding about the
individual professional contributions and that the transdisciplinary model is not intended to replace any of the
disciplines, but to enhance the service to the child by
ensuring that the child’s pathway is holistic.
Figure 5
Within any team and/or context, the particular skills and
competences of any individual team members will vary
depending on their training and experience. The specific
roles and responsibilities regarding the planning and
delivery of any child’s care will therefore also vary. Because
of this variation, these roles should be explicitly discussed
and agreed by the team around the child.
Strong professional leadership is essential to develop
appropriate trans-disciplinary working models that provide
a positive, integrated, streamlined experience for the child
and their family, while ensuring quality is maintained with
the necessary expertise within the system. When these
factors are addressed, the trans-disciplinary model
provides cohesive service delivery.
Models of multi-professional working
Multi-disciplinary working
Interdisciplinary working
Discipline A
Discipline A
CHILD
CHILD
Discipline B
Discipline C
Discipline B
Discipline C
Trans-disciplinary working
A
CHILD IN THE
ENVIRONMENT
B
16
C
Supporting children with speech, language and communication
needs within integrated children’s services
Recommendation 4:
Training of others, including parents, should be viewed as
a central activity for SLTs in order to maximise impact for
the child and their family
If competences are to be shared effectively with students,
less experienced members of the speech and language
therapy profession, colleagues from other disciplines and,
most crucially, parents, there needs to be greater
understanding of the therapeutic process. Speech and
language therapists training others require the skills to
impart insight into the precise therapeutic interactions
that make an activity a speech and language therapy tool
as opposed to merely an activity.
They also need the time to prepare training materials and
deliver training as an integral part of the service delivery
around a child and their family. Successful training of
others involved in the child’s care is crucial to achieving
real change for the child in terms of their speech,
language, communications and eating and drinking skills.
3.2 Planning for maximum impact
Recommendation 5:
Service planning for children with speech, language,
communication or eating/drinking needs should
always be in partnership with other agencies.
Recommendation 6:
Service planning should take account of the most
functionally communicative and socially appropriate
environment for effecting change.
This extends across the age range. Pre-school children
should be supported in the home or early years setting if
possible. The mainstreaming of Sure Start activities with
clinic approaches will facilitate this shift and children’s
centres and early years settings will become the most
appropriate base from which pre-school services can
operate. For children of school age, the school setting
continues to be the most appropriate place for support.
Practice example 2
Joint service planning for children’s services
Example 2a
The Bridgend Children with Disabilities Team is
made up of social workers, day care support workers,
family link workers, an SLT, occupational therapist
and physiotherapist. The CWD steering group
involves heads of service from the Therapies Health
Directorate and social services, as well as the
Children’s Partnership Coordinator. Thus planning is
informed by three Bridgend statutory agencies.
Contact Rosie Jones –
Rosie.Jones@bromor-tr.wales.nhs.uk
Example 2b
Glasgow City Council – Provision for Children with
Autistic Spectrum Disorder (ASD)
• An interagency framework group made up of
middle management representatives from
education (including psychological services), social
work, community paediatrics and speech and
language therapy.
• Developing an interagency approach to assessment,
diagnosis, reporting, sharing information and
supporting staff in mainstream schools which have
children with ASD
• Protocols for joint assessment and a format for joint
reporting
• Pack for mainstream schools: ‘Autistic Spectrum
Disorder – Information and Procedures Pack’
targeted to head teachers
• ‘Support and Development Group’ for mainstream
staff who have or are anticipating children with ASD
in their classes
• A multi-professional seminar resulting in an
Interagency Action Plan
Contact Pauline Beirne –
pauline.beirne@yorkhill.scot.nhs.uk
17
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Recommendation 7:
There is a need to define the parameters of an
appropriate advisory needs based and dynamic approach
to supporting children that integrates the concept of skill
mix both within the profession and across professional
boundaries. The term ‘consultative’ model should be
replaced by a more accurate description of the service
being delivered. The RCSLT supports the need for
research to further define and investigate the impact of
approaches, which rely on the implementation of speech
and language therapy advice by others.
The term ‘consultative model’ has not helped in
conveying the key principles of transferring skills and
competences to others in order that they can support
children more effectively throughout their daily activities.
It has been widely interpreted to mean anything from a
once a year visit to a school for annual review, to a six
week on, six week off model within mainstream school
with an assistant taking over in the six weeks off (Law et
al, 2000)42. Whatever approach to skill mix and sharing of
competence, the key role for SLTs as trainers and
educators is once again highlighted.
The positive development of service models that draw on
the skills of others within the child’s system – be they
parents, teachers, learning support assistants or others –
arose from the recognition that working at the level of
impairment (see the ICIDH-2 impairment, activity,
participation outline above) is in itself of limited value to
the total life experience of the child if they are not also
able to benefit in terms of activity and participation.
Unfortunately, where models involving the delegation of
tasks and programmes to others have been perceived as
resource saving strategies, the positive reasons for such
approaches have been lost. Fortunately, there are
examples of positive models where others within the
workforce around the child contribute to the achievement
of speech, language and communication goals. This is
important, as the demographics of the workforce
continues to change significantly.
The demographic data provided by the children’s
workforce unit 43 predicts a dearth of highly trained
professional individuals over the next 10 to 20 years. This
shortfall in the potential workforce will be attributable to
demographic and epidemiological effects rather than lack
of opportunity for training.
The development of new support worker roles is therefore
a logical way forward and such roles are already emerging.
For example, educational health workers who are
education-based staff with specific training for supporting
all health interventions for children in educational settings.
These support workers are assistant practitioners in the
sense they are implementing interventions devised by
qualified professionals. However, in order to be in these
roles they have had training and can demonstrate they
have developed the necessary competences to support
children within the educational setting.
18
Practice example 3
Multi-agency support worker roles
Example 3a
North West London Hospitals Trust Speech and
Language Therapy Department and Harrow LEA
Portage Service
Speech and language therapy assistant and portage
worker run the Early Bird Programme together in an
Early Excellence Centre
Contact Marie Luscombe –
maria.luscombe@nwlh.nhs.uk
Example 3b
Independent SLT developing the role of tutors,
teachers, support workers and classroom assistants
through training in order that they can support the
delivery of support for the child.
Contact Sheilagh Urwin –
family@urwin9969.freeserve.co.uk
Example 3c
Sure Start Hailsham and Eastbourne Downs PCT
Speech and language therapy assistant and Sure Start
home visitor work together to run the Basic Skills
Agency Early Start programme. This is a programme for
parents designed to improve basic skills and provide
practice opportunities to develop play and
communication with their young children.
Contact Suki Ahsam –
suki.ahsam@eastbournedownspct.nhs.uk
Example 3d
A speech and language therapist and assistant work
with a designated teacher [usually the SENCo] and a
designated TA in each school on a rolling programme.
‘Standard’ group programmes are demonstrated and
then run by the school staff and cascaded to other staff
as necessary.
Initially the group programmes focused on children
with additional needs and some vulnerable children,
but over time it soon became clear that the benefits
were much wider.
Contact Mary Auckland –
mary@aucklandsalt.fsnet.co.uk
Supporting children with speech, language and communication
needs within integrated children’s services
Considering the ‘horizontal’ spread of competence implies
role redesign that involves crossing boundaries at the
professionally qualified level. That is, looking at other
professional groups and considering where overlaps in
skills and competence might make a sensible case for one
or the other being involved rather than both. The ‘team
around the child’ approach for disabled children is an
example of a system that values individual professional
contributions, but challenges assumptions about who
does what and when 44.
Figure 6 (below) presents a diagrammatic representation
of the continuum of competences within the workforce
and the impact of this on the point at which an SLT can
safely delegate the delivery of interventions around a child.
The decision-making process around where to draw this
line for an individual child needs to be explicit. The
concept of risk assessment will be useful in exploring the
Figure 6
uniquely within
the remit of a
speech
and language
therapist
parameters involved. Where there is a high level of
competence within the child’s context, be that home,
early years school or setting, it may be possible for the
SLT to take on an appropriately advisory role. Where the
competence is less certain, then the focus of the SLT, may
be best placed in developing the competence in the
environment. The key point is that the place ‘the line is
drawn’ should be in response to the dynamic
environment and not set in time or place.
The concept of managing a child’s speech, language,
communication or eating and drinking goals as part of
the their daily routine, and therefore undertaken by the
people who are part of that routine, should be seen as a
positive option. This is not a dilution of a specialist
resource, but the effective implementation of an
ecological approach45 whereby the requirements of the
individual child and the setting where the goals will be
addressed are both taken into account.
Continuum of competences
could sit either with the SLT or with another
can
and should
be handed on
19
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Recommendation 8:
Service structures should reflect the changing context.
Highly specialist, principal and consultant therapists need
to use time to train, develop, coach and mentor less
experienced therapists who in turn need to be given the
opportunity to work with all caseloads. The most
specialist should focus their skills on the strategic
developments within their specialist area.
The highly experienced therapist should be used as a true
‘consultant’ in the sense that they can be clinically
accountable for a team of less experienced but qualified
registered practitioners. They in turn advise a team of
assistant practitioners and/or students in delivering the
programmes. The more senior therapist may have an
overarching responsibility for the delivery of services to a
large number of children without being directly involved
themselves for the majority of their time. This would
necessitate examining roles at every level, as the senior
practitioner may have direct regular contact with a very
small number of families at any one time. The allocation of
children and families throughout the team will be based
on clearly defined criteria at specific times in their
pathway through a service. Empowering the newly
qualified practitioner and valuing the expert are equally
important for future service delivery.
Practice example 4
Perth & Kinross SLT Surestart Project
The SLT Department is running a Sure Start funded
project that is extending the role of the SLT assistant.
Two NNEB(Equivalent)-trained staff have been
recruited. Following extensive in-house SLT training
the SLT(A)s are providing direct therapy programmes
to children in nurseries under the supervision of
therapists. Initial results show positive outcomes for
children, parents, nursery staff and therapists.
Contact Jeanette Seaman –
jeanette.seaman@tpct.scot.nhs.uk
20
3.3 Systems for strategy
Recommendation 9:
The RCSLT recommends that within each local authority
area there needs to be an SLT professional lead for
children, who can interpret national policy and ensure
that partnership working occurs in terms of integrated
commissioning of speech and language therapy provision,
strategic planning and operational delivery. This
professional lead should ideally be a member of key
strategic multi-agency planning groups and be
empowered to make key strategic decisions on behalf of
local speech and language therapy services.
The role of professional lead should also provide a focal
point in terms of professional standards for all speech
and language therapy provider services both within
statutory and non-statutory provider organisations
(including independent practitioners).
The introduction of the concepts of plurality and
contestability to the provision of statutory services
highlights the need for members of the speech and
language therapy profession, along with other AHP
colleagues, to engage at a strategic level. It will be
increasingly important for professional advice to be
provided to commissioners, who will come from
increasingly diverse backgrounds and experiences as
services come together across traditional agency
boundaries.
Those managing speech and language therapy services
need to:
• gain membership of key strategic multi-agency planning
groups
• have the required high level negotiation skills (including
in depth knowledge of the functioning of the different
agencies)
• actively influence at director level and at a strategic level
across agencies
Supporting children with speech, language and communication
needs within integrated children’s services
Recommendation 10:
The role of the SLT must be seen within the context of
the specialist and wider workforce. Commissioners need
to be aware of the unique contribution of SLTs across the
population base.
In considering the place of the SLT within the children’s
workforce it is essential to see the ‘whole system’.
The Workforce deployment pyramid for integrated children’s
services 46 (see Figure 7 below) offers a framework in which
it can be seen that SLTs have an equal role to play at all
levels of the ‘pyramid of need’. This model proposes that
it is equally as relevant to have an SLT supporting a child
with a complex disability as it is to be involved in the
preventative work aimed at the general population of ‘all
children’. The key factor is that the workforce dimension
of the model represents the pool of specialist resource
available for children at each level of need. The
suggestion is that an SLT working with a child with
specialist additional needs will sit as part of a large
workforce around that child and therefore needs to
consider the specific contribution that they can make as
an SLT in this context. A child’s speech, language,
communication or eating/drinking goals can be achieved
using a team around the child.
The model also implies that all levels of experience in terms
of SLT practitioner can operate at all levels of the pyramid.
Clinical experts are relevant in all areas of speech and
language therapy practice as are student therapists. The
rationale for ensuring that the unique contribution of the
SLT is relevant for all children lies in the changing context
as outlined in part 1 of this paper. In an inclusive model of
service delivery, which aims to deliver services in the most
accessible and effective way for children and their families,
it is essential that therapists can support at all levels and
across a range of settings. This model allows for the
possibility of a child with a complex communication need
to be supported via a children’s centre, nursery or
mainstream school in that the skills and competences
required can be present in all three as well as in more
traditional specialist centres and settings. The ‘whole
system’ approach needs to extend to include all settings in
which SLTs work.
An SLT working within universal services at a largely
population focused level may, on the other hand, find
themselves as a more significant proportion of the
specialist workforce. The numbers of children impacted
upon, however, will be significantly greater in this context
and therefore the proportion of ‘time per child’ for the
therapist working with ‘all children’ will be significantly
less than for the therapist working with the relatively few
children with additional needs.
Figure 7
Workforce deployment pyramid for integrated children’s services
Specialist Workforce
Specialist
services
SLT others
Children
with
additional needs
Proportion of
SLT time per
child
SLT others
Vulnerable
children
Targeted
services
Service
focus
SLT others
All children
Universal
services
Population
21
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Recommendation 11:
Managers and service leads should work together with
their AHP colleagues as well as colleagues from education
and social care, in the development of new roles, in
particular the development of consultants/specialist
advisory posts and cross-agency posts.
The development of consultant posts should offer
potential in integrated children’s services. A consultant in
disability, inclusion, or neonatology could be held by a
number of professionals and SLTs are in a strong position
to compete for such posts. The reports on how consultant
posts are emerging indicate that they are being created
where the local management are seeking to create the
role. The RCSLT therefore urges managers to actively seek
out those contexts where a consultant lead will enhance
services.
Practice example 5
Multi-agency working
Example 5a
COMET (Communication and Education Together)
project in Northern Ireland
Speech and language therapists employed as advisory
SLTs to enable teachers to identify and support children
with speech, language and communication difficulties
in mainstream schools. Emphasis on collaborative
practice, training and a consultative role for the SLTs
Contact Anne McMahon –
Anne.McMahon@seelb.org.uk
Example 5b
At I CAN Dawn House School a residential care officer
has a role across the school in supporting children with
augmentative and alternative communication (AAC)
devices. She uses her knowledge of communication
disability, together with technical expertise to support
staff in their knowledge, use and maintenance of hightech communication aid – as well as being involved in
running AAC groups for children.
Contact Alex Hall – Ahall@ican.org.uk
22
Supporting children with speech, language and communication
needs within integrated children’s services
Recommendation 12:
Management opportunities across agencies and across
professional boundaries should be actively developed.
The integration agenda relies on professionals from all
backgrounds engaging in the development of services in
new ways. In order to ensure that the needs of children
with speech, language and communication needs are
met, it is imperative that there is balanced representation
at all levels of service planning and management.
Care group management and teams based around
children’s journeys are now common within many
statutory organisations. The management arrangements
within an integrated children’s service are set to become
more diverse and based less and less on historic
professional groupings.
Practice example 6
Cross professional/Cross agency leadership
Example 6a – Operational
Oxfordshire Integrated Service Manager.
Since October 2004, the “language” strand of
Communication, Language, Autism and Sensory
Support Services (CLASS) has been managed as part
of an integrated service by one of Oxfordshire’s
speech and language therapy coordinators. The
integrated service manager (SLT) has dual
accountability – to the head of CLASS and to the
manager of children’s therapy services – and
manages: teacher team leaders, teachers, therapists
and therapy and teaching assistant staff across preschool settings, mainstream schools and additionally
resourced bases linked to mainstream schools.
Contact Liz Shaw –
Liz.Shaw@OxfordCity-PCT.NHS.UK
Example 6b – Strategic
Hackney Integrated Therapy Service
City & Hackney PCT and The Learning Trust (the
local provider of education services in Hackney)
jointly fund an integrated therapy service with SLTs
being employed by either organisation but managed
as one team. As part of the strategic management of
therapies within the integrated agenda the children’s
therapy manager is part of the SEN Senior Management
Team within the Learning Trust as well as part of the
health structures within the PCT. Service planning is
integrated so as to meet the strategic objectives of
both organisations.
Contact Marie Gascoigne –
Marie.Gascoigne@chpct.nhs.uk
3.4 Developing the workforce
In order to respond to the challenges of the integrated
children’s agenda and ensure the appropriate skills sets
are available within the workforce, there is a need to
consider training and continuing professional
development (CPD) at all levels.
Recommendation 13:
The RCSLT supports the development of placements that
offer student therapists a full range of opportunities as
part of their practice based learning and this would
include working as part of trans-disciplinary teams.
This should include opportunities to work independently
(with appropriate supervision) in schools and settings.
This view is reflected in the RCSLT position paper on
practice placements 47.
The RCSLT is concerned that newly-qualified SLTs are
sometimes expected to act as ‘consultants’ to other
professionals despite their limited experience. Part of this
concern arises from lack of specific experience as students.
This is an issue for which the responsibility lies with
practitioners as well as the HEIs in that students can only
access the placements they are offered. Increasingly
confident newly-qualified SLTs are emerging in areas
where placements in mainstream schools and other
settings, which offer real opportunities to manage a
caseload, are available.
Practice example 7
Student placements
Placements in mainstream schools in Greenwich
Teaching PCT
Students are placed in mainstream primary schools in
pairs for one day a week for one or two terms. The
supervising SLT attends the school four times per term.
The special educational needs coordinator (SENCO) in
the school is the main point of contact for issues arising
when the SLT is not on site. The SLT can be contacted
by mobile phone at any time. Students are involved in
assessment and therapy with pupils as well as joint
planning and discussion of ideas with education staff
and demonstrating activities to staff and parents. This
model was initially a pilot scheme following which a
list of essential criteria for a successful placement was
drawn up.
For further information contact Jan Baerselman,
Coordinator of Mainstream Schools Service,
jan.baerselman@nhs.net or Roz Weeks, Clinical
Manager of Speech and Language Therapy Services
to Education, roz.weeks@nhs.net.
23
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Recommendation 14:
Recommendation 15:
Speech and language therapists working with children
should undertake continuing professional development
(CPD) activities across health, education and social care
to develop knowledge and skills that will prepare them
for cross-agency roles.
The RCSLT values CPD activities that are not limited to
the health context.
The challenges of the changing context mean that
business and entrepreneurial skills sets will become more
relevant for senior managers. All speech and language
service leads should also develop excellent
communication and negotiation skills as part of a
portfolio of leadership competence.
Within education, horizontal skill mix could see the
emergence of new roles for SLTs as officers within
education structures as well as health professionals.
Integrated specialist learning support teams drawing
together specialist teachers and SLTs are not uncommon,
and in some areas reciprocal membership of senior
management teams across education and health are
being piloted. In Scotland, the creation of community
health partnerships led by social care will bring further
opportunities.
24
In order to respond as leaders in the changing context,
SLTs should recognise the importance of key leadership
skills. Service leads should not only ensure that they
demonstrate these skills, but also encourage leadership
development throughout the structures for which they
are responsible.
Supporting children with speech, language and communication
needs within integrated children’s services
4. Conclusions and way
forward
There are revolutionary changes underway in children’s
services across the UK. Speech and language therapists,
managers and commissioners are all being required to
think in new ways and embrace new structures and
processes.
In order to continue to keep the child and their family at
the centre of the arena, it will be necessary to continually
re-examine the professional view in relation to the
external context. Consequently, the recommendations set
out in this paper will be reviewed in 2008 and evaluated
in the context of the reality of services at that time.
The RCSLT envisages that, as well as informing joint
working within each of the home countries, the paper
will also provide SLTs with a framework to support local
service development and delivery.
The consultation involved in the development of this
paper has in itself initiated a process within the RCSLT
and its membership. The structures within the RCSLT that
will best support the membership in responding to the
changing context for children’s services are under review
as a result of this process. In addition, it is hoped service
planners and managers throughout the UK will be able to
use the frameworks outlined to develop services that will
best meet the needs of children with speech, language
and communication needs in the UK.
25
www.rcslt.org
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26
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28 www.shssb.org/partnership_working/wraparound/
29 Limbrick P. (2001) www.handseltrust.org/
30 Williamson K. (2001) Capable, confident and competent, RCSLT
Bulletin, 592, 12-13
31 www.rcslt-members.org/membersonly/comp-introduction.shtml
32 Children’s Workforce Strategy: A strategy to build a world-class
workforce for children and young people (DfES 2005) DfES/1117/2005
www.dfes.gov.uk/consultations/downloadableDocs/5958-DfESECM.pdf
33 www.skillsforhealth.org.uk/
34 Bloom L, Lahey M. (1978) Language development and disorders.
New York: Wiley
35 Bronfenbrenner U. (1989). Ecological systems theory. In R. Vasta
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child development. Greenwich, Conn: JAI Press
36 World Health Organisation (2001)
www3.who.int/icf/ebres/english.pdf
37 RCSLT Clinical Guidelines Edited by Sylvia Taylor-Goh (2005)
38 Communicating Quality 2 – Professional Standards for Speech and
Language Therapists. (RCSLT, 1996)
39 www.everychildmatters.gov.uk/_files/F9E3F941DC8D4580539
EE4C743E9371D.pdf
40 Service model for packages of support. Hackney Speech and
Language Therapy Integrated Service Handbook (2005)
41 After M Giangreco, J York & B Rainforth 1989, cited in Mackey, S
and McQueen J, 1998
42 Law J, Lindsay G, Peacey N, Gascoigne MT, Soloff N, Radford J
and Band S. (2000) “Provision for Children with Speech and
Language Needs in England and Wales: Facilitating Communication
between Education and Health Services” DfEE research report 239
43 Pay and workforce strategy for the children’s workforce: evidence
chapter (unpublished DfES 2004)
44 www.handseltrust.org/
45 Fey M. (1986) Language Intervention with Young Children San
Diego, California: College Hill Press
46 Gascoigne MT. (2006) Supporting children with speech, language
and communication needs within integrated children’s services,
RCSLT Position Paper, RCSLT London
47 RCSLT Position Paper: Practice Placements
Supporting children with speech, language and communication
needs within integrated children’s services
Notes
27
Supporting children with speech, language and communication
needs within integrated children’s services
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